Knopf Andreas, Ketterer Manuel Christoph, Hoffmann Thomas K, Laban Simon, Berghaus Alexander, Canis Martin, Jacobi Christian, Klussmann Jens Peter, Föringer Wendelin, Laszig Roland, Pfeiffer Jens, Bier Henning
Hals-Nasen-Ohrenklinik, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Otorhinolaryngology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany.
Eur Arch Otorhinolaryngol. 2024 Oct 22. doi: 10.1007/s00405-024-08990-6.
This retrospective multicenter study aimed to evaluate surgical versus conservative treatment in patients with hypopharyngeal and laryngeal cancer under real world conditions.
This study included 2307 patients diagnosed with hypopharyngeal or laryngeal squamous cell carcinoma (SCC) in five German tertiary head and neck centers between 01/2004 and 12/2014. Overall, 783 patients with advanced SCC consecutively underwent laryng(opharyng)ectomy (L(P)E). Patient chart data regarding age, sex, tumor location, TNM status, grading, indication for L(P)E, treatment modalities, R status, postoperative complications, and hospitalization time were analyzed. Patients with lacking data and incomplete staging and those who refused treatment or did not comply with the recommended treatment were excluded from survival analysis.
A slight but significant increase was observed in L(P)E, referring to an increasing rate of tumor recurrence. While T1/2N0M0 laryngeal and hypopharyngeal cancer patients showed comparable overall survival (OS) for surgical and conservative treatment, surgery showed significantly better OS in lymph node-positive individuals and locally advanced tumor stages. Tumor recurrence occurred in more than one-third of the cases. In particular, in early glottic cancer recurrence, L(P)E represents a curative and safe treatment option, whereas in supraglottic and hypopharyngeal cancer, L(P)E was associated with reduced survival rates. Notably, 36% of patients with supraglottic cancer and 59% of patients with hypopharyngeal cancer recurrence could only be treated with palliative care.
Comparable survival rates were demonstrated for cT1/2N0M0 laryngeal and hypopharyngeal SCC compared with primary chemo-/radiotherapy and larynx-preserving surgery. Better OS was achieved after surgery in nodal-positive patients and in those with locally advanced disease. Tumor recurrence should be anticipated in up to 39% of cases. Glottic cancer recurrence can be successfully and safely treated with L(P)E, whereas OS is reduced in hypopharyngeal cancer and possibly in supraglottic cancer.
这项回顾性多中心研究旨在评估在现实世界条件下下咽癌和喉癌患者的手术治疗与保守治疗。
本研究纳入了2004年1月至2014年12月期间在德国五个三级头颈中心诊断为下咽或喉鳞状细胞癌（SCC）的2307例患者。总体而言，783例晚期SCC患者连续接受了喉（咽）切除术（L（P）E）。分析了患者病历中有关年龄、性别、肿瘤位置、TNM分期、分级、L（P）E指征、治疗方式、R状态、术后并发症和住院时间的数据。生存分析排除了数据缺失、分期不完整以及拒绝治疗或未遵循推荐治疗的患者。
观察到L（P）E有轻微但显著的增加，这与肿瘤复发率的增加有关。虽然T1/2N0M0喉癌和下咽癌患者的手术治疗和保守治疗的总生存期（OS）相当，但手术在淋巴结阳性个体和局部晚期肿瘤阶段显示出显著更好的OS。超过三分之一的病例发生了肿瘤复发。特别是，在早期声门癌复发中，L（P）E是一种治愈性且安全的治疗选择，而在声门上癌和下咽癌中，L（P）E与生存率降低有关。值得注意的是，36%的声门上癌患者和59%的下咽癌复发患者只能接受姑息治疗。
与原发性化疗/放疗和保喉手术相比，cT1/2N0M0喉癌和下咽SCC的生存率相当。在淋巴结阳性患者和局部晚期疾病患者中，手术后OS更好。高达39%的病例应预期会发生肿瘤复发。声门癌复发可以通过L（P）E成功且安全地治疗，而下咽癌以及可能的声门上癌的OS会降低。
